Diagnosis and management of early and delayed cardiac tamponade complicating percutaneous cardiac intervention

Objective To summarize the incidence,diagnosis, clinical character, management,and outcome of early and delayed cardiac tamponade complicating perc utaneous cardiac intervention (PCI).MethodsWe analyzed a continuous database of 6 306 PCIs from Jun.1994 to May 2003. Results Cardiac tamponad e were observed i n 10 cases of 6 306 PCI procedures (0 16%) Three cases were diagnosed in the c at heterization laboratory (early cardiac tamponade),and 7 had a delayed presentati on (delayed cardiac tamponade,mean time 2 6 h after PCI) The mean age in patie nt s with cardiac tamponade was significantly higher than that of patients without cardiac tamponade[(66 8±9 3)yr vs (55 4±13 3)yr, P 0 01].Most of the car diac tamponade patients who complicated with percutaneous transluminal coronary angioplasty had multivessel disease and complex lesions.Three patients with ear l y cardiac tamponade had a sudden drop in blood pressure and presented a transpar ent area around the heart under LAO project fluorography during PCI.The early c l inical presentation of 7 delayed cardiac tamponade patients was sudden bradycard ia and hypotension,and the response to intravenous atropine and dopamine was tac hycardia without blood pressure recovering.A moderate or large volume of perica r dial effusion was observed in 8 patients by an urgent echocardiogram.Two early c ardiac tamponade patients were directly treated with emergency surgical operatio n.Pericardiocentesis was performed in other 8 patients,but only one of th em requ ired further surgical management.Protamine was used in 5 patients intravenously and in 4 patients through injection into local pericardial cavity.All 10 patie n ts were successfully treated. Conclusion The key points for rapid diagnosis of tampona de include strengthening sense of diagnosis,early identification of clinical presentation and perfor ming emergency echocardiogram.Satisfied therapeutic result could be expected by pro mptly pericardiocentesis,introduction of protamine and necessary surgical interv ention.